Stupor and Coma Flashcards
Impaired consciuosness is a result of
- diffuse b/l impairment of both cerebral hemispheres
- failure of brainstem ARAS
or - Both
asterixis is seen with
hepatic failure. eyes also adducted and down.
what things do we want to check in a patient with stupor and coma - generally
pupillary response EOM motor response corneal reflex respiratory patterns.
Purpose of the neurologic exam
to determine the nature and location of the process that caused the impaired consciousness
narrow the differential
3 ps of pinpoint pupils
pontine lesion
oPiates
Pilocarpine
aniscoria - which pupil is abnormal
large one - should fail to constrict to light
small one - should fail to dilate in dark
pupils enlarged UL usually indicates
parasympathetic dysfunction (usu cn III)
pupills enlarged b/l
b/l CN3 lesion, post ictal, barbiturates
pupils constricted usually idicates
sympathetic dysfunction
pupils mid position and unreactive =
parasym and symp dysfunction (midbrain)
roving eyes
conjugate suggests:
disconjugate implies:
brainstem intact; brainstem lesion
conjugate deviation at rest
hemispheric lesion destructive vs irritative
destructive - toward lesion
irritative - away from lesion
conjugate deviation at rest
brainstem lesion destructive
destructive away from lesion
in diffuse/metabolic disease causing stupor or coma, the pupils are usu
normal
oculocephalic and oculovestibular tests are evaluating the integrity of the
pons
